Provider Demographics
NPI:1215021480
Name:CROWDER, JOHN V JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:CROWDER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:160 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3160
Mailing Address - Country:US
Mailing Address - Phone:831-728-2020
Mailing Address - Fax:831-728-4739
Practice Address - Street 1:160 GREEN VALLEY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3160
Practice Address - Country:US
Practice Address - Phone:831-728-2020
Practice Address - Fax:831-728-4739
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00C336820207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0074000Medicaid
CA00C336820Medicare ID - Type Unspecified
A35346Medicare UPIN